THR- WHAT IS THE FDA THINKING?

A Wolf found great difficulty in getting at the sheep owing

to the vigilance of the shepherd and his dogs.  But one day 

it found the skin of a sheep that had been flayed and thrown

aside, so it put it on over its own pelt and strolled down 

among the sheep. The Lamb that belonged to the sheep, whose 

skin the Wolf was wearing, began to follow the Wolf in the 

Sheep's clothing; so, leading the Lamb a little apart, he 

soon made a meal off her, and for some time he succeeded in 

deceiving the sheep, and enjoying hearty meals.

	Appearances are deceptive.

The FDA has approved a Phase II-B study on 97% nicotine-free 

cigarettes based on the following:

Dr. Hatsukami’s study compared the quitting efficacy of a VLN cigarette (containing 22nd Century’s proprietary VLN tobacco), an FDA-approved 4-mg nicotine lozenge, and a low nicotine cigarette (containing 30% of the nicotine of a typical cigarette) in a total of 167 patients treated for 6 weeks (Hatsukami et al. 2010). Point-prevalence abstinence at 6 weeks after the end of treatment was 47% for the group using the VLN cigarette, 37% for the nicotine lozenge group and 23% for the low nicotine cigarette group (p=.0357). Furthermore, the VLN cigarette was associated with greater relief of withdrawal from usual brand cigarettes than the nicotine lozenge. The protocol of 22nd Century’s upcoming Phase II-B clinical trial is similar to that of the University of Minnesota trial. Unlike the low nicotine cigarette, the VLN cigarette was not associated with compensatory smoking behaviors. By the end of the 6-week treatment period, patients in the VLN group (whether they quit or not) on average were smoking 12 VLN cigarettes per day, compared to a baseline of 19 cigarettes per day of their usual brand.

The pub-med abstract:

Abstract

AIMS:

To examine the effects of reduced nicotine cigarettes on smoking behavior, toxicant exposure, dependence and abstinence.

DESIGN:

Randomized, parallel arm, semi-blinded study. Setting University of Minnesota Tobacco Use Research Center.

INTERVENTIONS:

Six weeks of: (i) 0.05 mg nicotine yield cigarettes; (ii) 0.3 mg nicotine yield cigarettes; or (iii) 4 mg nicotine lozenge; 6 weeks of follow-up. Measurements Compensatory smoking behavior, biomarkers of exposure, tobacco dependence, tobacco withdrawal and abstinence rate.

FINDINGS:

Unlike the 0.3 mg cigarettes, 0.05 mg cigarettes were not associated with compensatory smoking behaviors. Furthermore, the 0.05 mg cigarettes and nicotine lozenge were associated with reduced carcinogen exposure, nicotine dependence and product withdrawal scores. The 0.05 mg cigarette was associated with greater relief of withdrawal from usual brand cigarettes than the nicotine lozenge. The 0.05 mg cigarette led to a significantly higher rate of cessation than the 0.3 mg cigarette and a similar rate as nicotine lozenge.

Conclusions:

Observed-

• There is a major behavioral part in the act of smoking cessation.
• 0.03 (97% free) nicotine X-22 products were superior in a SEMI- blinded study.
• Post endpoint there was a decrease in the number of X-22 cigarettes smoked in those who did not quit compared to pre-study smoking levels.

Questions-

• Why is there an FDA study that is making the assumption that nicotine cessation is the issue.
• Is it ethical to use a non-carcinogenic variable (nicotine) as a variable, when the true vectors of carcinogenicity are still part of the X-22.
• Is it ethical to report the decrease from 19-12 cigs per day in the 0.03 mg group, it suggests that  smoking less would be good and opens a potential message that these may be marketable as beneficial even if cessation does not occur.
• Relapse rates- wonder what 3, 6, 9 month follow-ups were (not reported in a study about 2 years old.
• Do the X-22 decreased nicotine cigs still have other alkaloids (MAOI active?).  These alkaloids have been looked at as why a 2 day withdrawal time frame for pure nicotine is extended to much longer time when cigarettes are involved.

Insanity-  We KNOW that tobacco combustion products are the source of carcinogenicity.  It is not unexpected that levels of exposure to carcinogens would decrease if less tobacco is consumed.

What is the FDA doing running trials on smoking cessation with the variable nicotine delivered by a tobacco leaf product? Why would it not be more logical to use a tobacco free vehicle as the delivery system?  Don't they look happy, reminds me of a 60's tobacco commercial... X-22, 22nd Century's PRESCRIPTION......................

AHHHH! Prescription based smoking cessation aid.  Welcome back Pharma and Big Tobacco.

The wolf in sheep's clothing.  Nicotine free tobacco (genetically engineered) and packaged to taste, smell and smoke like a cigarette.  Prescription requirement will obviously make them very expensive. This appears to be tobacco cessation genocide.

Like lamb's to the slaughter-

This company is currently headquartered in Williamsville, N.Y., whose soccer team we crushed 8-0 back when I was in 12th grade.  

Chantix: Could it be Satan, and the new xx22 nicotineless cigarette,

The photo at the right represents a smoker at 50. It is of a  person who had smoked one pack per day for 20 years.  There is a slight hyperinflation, maybe- 5 of 9 radiologists stated that in a report that was published years ago in a journal that I am afraid I cannot quote.  At least that is honesty, so if you like, go ahead and discount this part of the blog.  

It is merely here to point out that the old familiar chest X-ray is a very poor indicator of early lung disease. It is just too nonspecific.  If you see the tumor, you are fairly sure that the tumor is in its advanced stages.  CT is better, but a recent study suggested that CT may actually increase the number of cancer deaths.  15-20% of all lung tumors are in non-smokers.  

So why start a blog on Chantix with the Church Lady and a chest Xray?  Because I like the chest X-ray and the Church Lady reflects the title.  

Somewhere in the deep core of the mind- there is evolving an understanding of how we unconsciously relate images to:

• self reflection 
• assessment of worth
• and envisionment of future self.

There are researchers at the University of Michigan

(go Appalachian State!) who through imaging 

techniques are looking at the role of this area in the

effectiveness of cigarette cessation ads.  Iterestingly

this is also an area that is ablated when frontal

lobotomy is performed and may have a role in

Schizophrenia.

I would suggest that it also has a role in the effectiveness of pro-smoking material.

This area lights up on scan when a person is affected by a anti-tobacco ad.  The follow-up to this is still in the works, but inferences that calming, cigarette ads may alter the envisionment of harm and lessen the cognitive perception of what tobacco does over time are an reasonable hypothesis.  The shocking images on tobacco products may serve to affect some smokers through self reflection and envisionment of future harm.

CHANTIX (CHANTOX in my book)

So Chan(p)tix- where does this fit in.  Chantix is varenicline, a weaker binding agent at the nicotine receptor and thus is intrinsically an ideal agent to alleviate cravings and displace nicotine, in a competative manner, and therefore decreasing smoking behaviors.  It is called a partial agonist as it binds but does produce the brains expected response.  

It also has a black box warning on the packaging matreial- risk of depression and suicidal thinking that are not always reversible and now increases cardiac risk 72% in users.  It is a dangerous and pathological entity that has no data on population risk (except to put the burden on the doctor to screen for the their patient's mood and cardiac status.

THE POINT

Chantix is the Corvair of Ralph Nader fame.

MMMMMMM- could it be SATAN?

Or are smokers seen in the average ANTZ mentality as disposable.  If any other drug had come out with the suicidal ideation and complication findings that Chantix has it would be hauled off the market immediately.  Makes sense in the ANTZ mentality- save a few with it (because it does statistically work- barely) and if a few die to get a few off, it is the smoker's fault for picking up the nasty habit.  If this were a diabetic or cardiac drug (see initial studies with citalopram and Hismanil), they would be removed for study.  Chantix- it's for people who will die anyway.  And of course the recent CNN report says; well it helps some, "I had a friend who tried everything else......" and that it seems to help some.  So does nicotine.. it helps some people.

I took Chantix, and have been on antidepressants since.  I hadn't been chronically before.

The superior race of ANTZ makes no suggestion that this is a problem.  The main message is smokers are expendable.   

NOW VERY LOW NICOTINE CIGARETTES

In its schizophrenic manner the XX22, a <5% vs marlboro nicotine content agent is being funded by the FDA for Phase IIb studies.  Who just punched me in the head, support nicotine free cigarettes in a combustion based delivery system and you get tar and ash.  The FDA is looking for a quick fix with solo control on outcome.The FDA has already stated that the tobacco smoke is dangerous. (More to come).

You just cannot argue with a mind fixated on safer cigarettes through the removal of nicotine.  Those 4000 chemicals and carcinogens are still there.

What frightens me is not tobacco ads- it is having a significantly discriminatory bias against e-cigs and SNUS that is found in the agency leading the fight against tobacco using the term harm reduction and talking of risk related tobacco taxation (more later).

I'll leave it to the media to express my last point-

Network-the movie Peter Finch

John Cleese on extremism

And I am mad as hell, and extremists beware, your the partial agonists of truth.  Multiple studies show e-cigs and SNUS are agents beneficial to the Harm Reduction effort.  Drs. who remove their patients from nicotine only or reduced harm agents- you are practicing genocide in some of those you recommend they cease alternative nicotine sources or quit cold turkey.

Remember those who analyze everything they read, whether pro their cause or against their cause will learn from both.  The ANTZ and the Harm Reduction Faction have their diehards.  Every time you look in a mirror you see yourself as you believe other's see you, we must always remember that the image in the mirror is reversed- it is just a reflection and reflections reverse our features.

Gotta go, need to open a window and say a few words.

AS THEY SEE US

Echolalia

One of the greatest victories in science is when your competition can't do anything but recant ancient studies as their only means of validating their point.  If I here the words:

1. Diethyl Glycol
2. Trace cancer causing agents.
3. We don't know how safe they are.
4. There are already nicotine replacement therapies for those who want to quit.
5. Chantix.
6. They need to be pulled of the market until we know they are safe.
7. Mights, possiblies, maybes and coulds.

in any article, paper, newsprint or health reporter's babblings- to word it lightly- I

will be using a large portion of their Cloud to respond.

First- I DO NOT PLAN IN THE NEAR FUTURE TO QUIT NICOTINE.

There I said it, may the tobacco temperance league choke on that line.  I enjoy vaping.  I enjoyed smoking. I  am not planning on quitting.  E-cigs were destigned to replace tobacco, not help me quit.

So give it up.  If I have to I'll grow it myself (lived in N.C. it isn't that hard) and extract the nicotine myself (I wonder if they will spray my land with Paraquat or will I come up on the Power Company, "he's using too much power, must be growing something" list).

Right now there is a wonderful thing happening in vaping, there are organizations like the newly formed ATACA in Australia, CASAA in the USA and EUUC EK in Great Britain.  These groups are the grassroots defenders of our freedom to use less toxic nicotine products. I was humbled and speechless sitting on a Skype call listening to their words, knowledge and bravery.

I listened to an ABC local broadcast on Vaping may be more dangerous than smoking.  The only factual statement in the entire story was the Diethyl Glycol in one of 18 bottles of e-juice tested.  All the experts said maybe's, could's, presumably and might be less safe. In that story they covered a woman whose Dr. had convinced a 1 year cigarette free vaper to toss out here equipment.  If and when she smokes again the coffin nails were fashioned by ABC, her M.D. and the star health reporter.

With e-cigarettes, they don't kill- not one single death related to them.  Minds that work this way kill.  They look to ban them: completely, through bias and coverage obscura.

Ban e cigarettes as the chart at right predicts- 500 people who have to go back to the "safe alternative", smoking, will die daily.  Journalistic murdering spinners of their anti-nicotine bias must get free lunches from the mortuary lobby.

And most experts will tell you nicotine is NOT the problem.  It may not be the true alkaloid in tobacco that causes the prolonged withdrawal.  That constant line about what is in e-cigs (PG, VG, Nicotine, flavouurng and water).  Can you tell me what is in tobacco smoke- 60 known carcinogens and 4000 other chemicals.  At least the one's in e-juice are FDA approved individually.

William Osler, MD who founded modern medicine emphatically stated, "of all else, at first do no harm."

That was 150 years ago.  How much we have progressed.

And a special thanks for the magnificent recent Ashtray Blog of James Dunworth and his pictorial of the proposed global cigarette labeling changes.    Look it up- it is real journalism.

So keep on being informed about the 1 of 18 samples with DEG below the federal toxicity level.  That's the Echolalia of the anti's.  Echolalia, a disorder where you here the same sound repeatedly. 

HAMLET TO NICORETTE

Hamlet's line, "there's special providence in the fall of a sparrow," relates well to courage and originates from a Biblical passage in the Book of Mark (read on, this is certainly not a sermon). relating an external force to the fate of any venture, decision, or action- be it successful or failure. 

The course of vaping is in providential hands, and the proponents courageous people who walk forward into a battle that has already been declared by many as a resurgence of the Big Tobacco (BT) experiences of years back.   BT was "busted" for suppressing data showing the harms of smoking and all of tobacco was guilty by association and became the scapegoat for all society's ills.   The fall of BT's image after non-disclosure and frank suppression of data is possibly the greatest act of providence, we as vapors, have in our corner.

The ultimate result of the repugnant acts of BT was a mantra that has been repeated for our entire lives, tobacco is bad in any form. A fictional expo As a result we came to believe that the tobacco plant was inherently "unhealthy" and anyone who would use it (Einstein, Lincoln, Twain, the Kennedy's and J. R. R. Tolkien spring to mind) must be stupid, rebellious, evil, dirty, subhumans deserving a slow painful death after years of cancer and heart and lung disease. The smoker was a bane to society, exponentially increasing health care costs, spewing secondary smoke on our beloved children and polluting the earth with the byproducts of tobacco use, specifically filters that won't degrade and the clinging residue of the smoke that layers itself over surfaces.  


But amazingly, the TRUTH has been sitting in plain sight for decades: At least 99% of the harms and risks and nuisances and deaths and diseases that are in any way related to tobacco use can be directly attributed to the direct or indirect hazards and byproducts of combustion.

 In our community there is an open dialogue of this sort that leaves our comments and data open to public scrutiny. Even before the BT fall from grace, tobacco was seen in a negative light. Mark Twain wrote multiple lines about his experience with tobacco- far before the PM and other companies were even in the sights of the public. What we must realize was said well months ago by Sam Munro when he stated that he still considered himself a smoker. There is no shame in any label one places on oneself or is placed on one by others. Nor is there ant problem with taking the stand strongly that, "I am not a smoker, I vape." It is your internal frame of refeence, and your internal perception of vaping and smoking that is important individually. To consider yourself an ex-smoker when you are vaping is totally correct, to consider yourself a smoker when you only vape is also totally correct. There is a dualistic truth in this concept that is that special providence, that courage. The external world has already moved, if only slightly to see the difference. This is complicated by the visual similarities of smoking and vaping. The important idea here for my own perception is that time will be the test of the outcome of vaping and that we are the pioneers of this practice. It is not my business or care of your perception of whether vaping is a replacement, a change from or a separate form of smoking. What is important is transparency. What is important is that the true difference between the two be validated and spread widely. What is important is that there be unity among vapors in the eyes of the public.


This is not snake oil, it is a real and viable means of harm reduction when using nicotine. It is personal choice on how one obtains nicotine (smoking, gum, vaping), but it is not necessary to potentially argue over the terms we as vapors use to describe ourselves. the providential direction will be that of our work and our belief in the cause- evangelism through personal stories and the conveyance to others of our experience in the manner that Jesus (not preaching) sent forth his believers in small groups to share the message. So when someone says- I didn't know you smoked I reply, I don't- I vape. And from there the discussion and the teaching and the message evolves and is spread. Peace-vape on.

Hamlet's line, "there's special providence in the fall of a sparrow," relates well to courage and originates from a Biblical passage in the Book of Mark (read on, this is certainly not a sermon). relating an external force to the fate of any venture, decision, or action- be it successful or failure. 

The course of vaping is in providential hands, and the proponents courageous people who walk forward into a battle that has already been declared by many as a resurgence of the Big Tobacco (BT) experiences of years back.   BT was "busted" for suppressing data showing the harms of smoking and all of tobacco was guilty by association and became the scapegoat for all society's ills.   The fall of BT's image after non-disclosure and frank suppression of data is possibly the greatest act of providence, we as vapors, have in our corner.

The ultimate result of the repugnant acts of BT was a mantra that has been repeated for our entire lives, tobacco is bad in any form. A myth sprung from this that has taken a natural plant from the magical and wonderful substance Columbus and other early traveler's to the New World discovered, and one indigenous populations peereived as sacred or at least medicinal to an enslaving and evil entity.  As a result we came to believe that the tobacco plant was inherently "unhealthy" and anyone who would use it (Einstein, Lincoln, Twain, the Kennedy's and J. R. R. Tolkien spring to mind) must be stupid, rebellious, evil, dirty, subhumans deserving a slow painful death after years of cancer and heart and lung disease. The smoker was a bane to society, exponentially increasing health care costs, spewing secondary smoke on our beloved children and polluting the earth with the byproducts of tobacco use, specifically filters that won't degrade and the clinging residue of the smoke that layers itself over surfaces.  


Amazingly, the simple truth has been sitting in plain sight for decades: At least 99% of the harms and risks, nuisances, deaths and diseases that are in any way related to tobacco use can be directly attributed to the direct or indirect hazards and byproducts of combustion.  The carcinogenic and destructive materials came from here

 In our community there is an open dialogue of this sort that leaves our comments and data open to public scrutiny. Even before the BT fall from grace, tobacco was seen in a negative light. Mark Twain wrote multiple lines about his experience with tobacco- far before the PM and other companies

were even in the sights of the public. What we must realize was said well months ago by Sam Munro when he stated that he still considered himself a smoker. There is no shame in any label one places on oneself or is placed on one by others. Nor is there ant problem with taking the stand strongly that, "I am not a smoker, I vape." It is your internal frame of refeence, and your internal perception of vaping and smoking that is important individually. To consider yourself an ex-smoker when you are vaping is totally correct, to consider yourself a smoker when you only vape is also totally correct. There is a dualistic truth in this concept that is that special providence, that courage. The external world has already moved, if only slightly to see the difference. This is complicated by the visual similarities of smoking and vaping. The important idea here for my own perception is that time will be the test of the outcome of vaping and that we are the pioneers of this practice. It is not my business or care of your perception of whether vaping is a replacement, a change from or a seperate form of smoking. What is important is transparency. What is important is that the true difference between the two be validated and spread widely. What is important is that there be unity amongst vapors in the eyes of the public. This is not snake oil, it is a real and viable means of harm reduction when using nicotine. It is personal choice on how one obtains nicotine (smoking, gum, vaping), but it is not necessary to potentially argue over the terms we as vapors use to describe ourselves. the providential direction will be that of our work and our belief in the cause- evangelism through personal stories and the conveyance to others of our experience in the manner that Jesus (not preaching) sent forth his believers in small groups to share the message. So when someone says- I didn't know you smoked I replly, I don't- I vape. And from there the discussion and the teaching and the message evolves and is spread. Peace-vape on.

‎10 Reasons not to Vape

Humbug!

We all go to the same end

In the most forceful manner I repeat Humbug!

Yes, Humbug I say, Humbug!

I was reading in a post written by a fervent 

anti-tobacco megalomaniac who simply stated

that his greatest wish was that every smoker 

be given full access to as much tobacco as he or she could tolerate and that they smoke themselves to death as quickly as possible. This would rid the earth of the scourge of the foul smelling creatures that spread their filthy habit throughout humanity.

Humbug!

I will not waste words commenting on a mind that is fixated on selective genocide
except to say that later in his passage he pronounced the inclusion of vapors and
SNUS spitters in his category of less than human tobacco consumers.  His picture
put him in his late 50's or possibly early 60's.  He also commented that he had
smoked for 20 years and one day just put them down.  I congratulate him for
that capability. He is one of a very few that can shed nicotine addiction so easily.
I also congratulate him for being one of the many smokers who I modeled after
to start smoking. In the late 60's tobacco was beginning to be seen as a public
health issue. Availability and acceptance were universal. I smoked in my college
classes, in cinemas, in grocery stores, in hospital waiting rooms,and airplanes.
Slowly there was a limited effort to curtail use that spiraled when Big Tobacco
and other consortiums started to react and produced low tar and nicotine products.

Still the people who were using tobacco quit every New Year's day for several
hours or quit for weeks or months to only find they had added 20 pounds and
were still craving tobacco.  Big Pharma to the rescue with gums, lozenges and
inhalers. Success rates minimal.

Then the medications Champix and Wellbutrin. They will get their page later.

In the middle of the last decade a device called the e-cigarette emerged.
Nicotine in a solution heated by a coil and gradually millions of people
throughout the earth found this a way to decrease or stop tobacco burning
as a means of smoking cessation.  Now my expert friend and his factions
want to equate e-cigarettes with smoking.

Humbug!

There only common ground is nicotine and a white exhale after inhalation.  But
more about that later.

So factions are trying to ban e-cigarettes from the semi-moronic stance that they
both emit white stuff.

I am a list maker by habit and it seems that I must try to find a reason to stop
the dreaded vaping;  Here is my top ten list, maybe it'll help me stop a
non-burning act of getting nicotine and I can start cigarettes and the 60
carcinogens (nicotine not one) of them, and 4000 other chemicals.  Vaping
is nicotine and a vegetable glycerin or PG vehicle which is touted by Boston
University to be 99% safer than cigarettes.:

Top 10 Reasons Not to Vape


1.  They don't fit behind your ear for that cool 50's
             look.


2.  You can't use. "can I bum a light", as a pick-up
             line at a bar.


3.  You can't flick them out the car window at night
             and see those cool trails.


4.  They may cause you to get up late because you
             don't wake up hacking up a lung.


5.  They don't give you that manly smell to your
             clothes.


6.  You don't get to carry those really cool Jeff Gordon
             lighters.


7.  You can't use the excuse that you are too short
             winded to help your neighbour move.


8.  You don't get Marlboro coupons to trade for that
             really neat Marlboro Jacket.


9.  They don't burn holes in your clothes so you can't
             use that as as excuse for a shopping spree.


10. They are not FDA approved.




Humbug- it didn't work.  Guess I'll have to try something
else..... more to come.

Truth, Lies and Poppycock

Blogs are supposed to opinionated.  The are intended to put ideas that are valid out there for the perusal of any eyes to see.  They are a person's interpretation of truth and a way of getting a message out to anyone who cares to spend a few minutes delving into another human being's mind. 

Poppycock, the are narcissistic and self indulgent viewpoints that feed the ego of the blogger.

They are not subject to prepublication peer review and as such have credence only if they are followed. It is from this frame of reference that this blog resurfaced, was renamed and reinvented.

This blog written to attempt to keep up with the world of THR- Tobacco Harm Reduction.  It is framed from a biopsychosocial perspective.  That there is an interdependence and undeniably linked relationship between biochemical processes, psychological makeup and social experiences and pressures.  THR understanding requires the objective and subjective interpretation of how each individual has biological individuality, thought processes that are unique and sociocultural experiences that are different and that each piece of that mixture causes external interpretation of a situation to evoke its own conclusion. We are not cast from the same mold.  In saying that we are also very much alike in this models framework.

Smoking tobacco is a well studied entity that is certainly harmful to multiple body systems.  The smoker knows this and continues, the most likely candidate for this continuing pseudo-denial is nicotine and the positive reinforcement of the act of smoking.  Pavlovian, behavioral, cognitive and pleasure seeking schema all fall into play. It has shown to be one of the most difficult addictions (define that as you like) to break. 

As Mark Twain observed,"...when they used to tell me I would shorten my life ten years by smoking, the little knew the devotee the were wasting their puerile word upon-- the little knew how trivial and valueless I would regard a decade with no smoking in it!."and "As an example to others, and not that I care for moderation myself, it has always been my rule never to smoke when I sleep and never to refrain when awake."

Nicotine is a powerful chemical agent within the brain, it increases alertness and stamina. It also causes nicotinic acetylcholine receptors to up-regulate- increase in number, and thus causes a biological change in the brain that partially accounts for the cessation withdrawal.  Millions die globally from tobacco related deaths.  Statistical analysis shows us that there is an average number of years lost per cigarette consumed.  Ah statistics, a wonderful and important area- but interpretable.  Why does one smoker die of a tobacco related disorder and another seem barely phased lighting up at 80.  My own father had an up to 3 pack habit and at 79 had lung function tests that showed no significant difference from the norms of his age group. We are all different, we are genetically a maelstrom of diversity.

People with psychiatric disorders tend to smoke more than those without such maladies.  Schizophrenics and Bipolar Disorder inflicted individuals smoke far above the normal statistical rate.  They appear to be self medicating. Thus psychological makeup plays a role in smoking. One remarkable observation is that many people who quit for years start back despite their memory of the pains of withdrawal.

Socially, if you grow up in a smoking family you are more likely to smoke.  Is that genetic as well or simply parental modeling.  The average smoker starts mid teens, and usually due to peer pressure from their social groups.

THR is not about simply decreasing risk and harm.  It is also about education and prevention of initial cigarette initiation. Education is thus a part of reduction strategies, one that has limited success to date as adolescents see themselves as immortal, I'll quit later and impervious to the negative outcomes.

THR's main focus should be at decreasing the harm from tobacco in those that use but cannot or have the Twain perspective. Tobacco smoke is the result of combustion of the tobacco leaf.  Combustion produces a chemical change in many of the compounds in tobacco.  The resultant agents have varying degrees of pathological outcomes- some are carcinogenic (at least 60 of the 4000 plus produced on tobacco burning.  Nicotine is in itself not the carcinogenic agent.  So gums, patches and inhalers with nicotine were sanctioned for cessation.  Drugs like Chantix (I will be blogging on that in a future blog) arose.  Community support groups, hypnosis, aversion therapies and Nicotine Anonymous have evolved.  Quit rates after six months are still  very low.One of the problems with these methods is their one sided treatment.  There is a complex array of behaviors that encompass smoking.  The oral inhalation, throat hit (feeling of tobacco smoke hitting the throat), the hand holding, and many more.  These other methods treat the biological but not the psychological aspects of smoking.

In 2006 Vaping was introduced into the smoking world. The use of a non-combustible technique to vaporize a nicotine and propylene glycol or vegetable glycerin solution which was inhaled like a cigarette (to be called analogue in the future) to mimic the behavioral and the biological effects of smoking.  Vaporization is a physical change  from liquid to droplet vapor,  The result the 4000 compounds are eliminated.  People at first called it a  fad- it is now a potential revolution in THR.  The exhaled vapor looks like smoke and the physical appearance of smoking have taken smokers to ex-smokers (although many claim they still consider themselves smokers, just not analogue  smokers. Subjective reports from vapors is that they feel better in weeks.

This is not nicotine cessation, it is much like gums or patches.  Many continue to vape at nicotine levels that arevape after going to zero nicotine.  It is Harm Reduction.

The exhaled vapor looks like smoke but is more like the exhaled are on a December Day in Northern Ontario.  It is vapor- not smoke. There is no match and no combustion.

And all was well- except the zero tolerance factions who want nicotine banned in all forms equate the smoke with the vapor, talk second hand smoke talk and a potential life saving agent becomes attacked. Then there are organizations like CASAA.org and many forums that fight for the right to THR. 

There is a battle out there and it is filled with have truths and lies. Anti-smoking groups spin THR into perpetuating the habit, influencing the young to start "safer" smoking- which is a speculation, vaping is not 100% safe. Boston University said it was 98-99% safer than smoking.

So enough for now.  Twain was prolific on smoking and this last paraphrase speaks it all for smokers- "Quitting smoking is easy. I have done it a thousand times."

And finally from Hippocrates- 'at first do no harm."  The anti's that would ban vaping will only push people back to smoking, thus increasing their potential morbidity.